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Introduction1
With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6 trillion per year by 2027 (CMS, 2019), policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to health, there is growing recognition that social determinants of health are important influences on population health.2 Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health (Hood et al., 2016; McGinnis et al., 2002). Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access
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1 The planning committee’s role was limited to planning the workshop, and this Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
2 According to the World Health Organization, the social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. See https://www.who.int/social_determinants/en (accessed July 29, 2019).
to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs.
To explore the potential effect of addressing non-medical, health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the Board on Population Health and Public Health Practice of the National Academies of Sciences, Engineering, and Medicine (the National Academies) held a full-day public workshop titled Investing in Interventions That Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical, health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, health systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical, health-related social needs.
The presentations and discussions highlighted in this Proceedings of a Workshop provide a general discussion of the issues, trends, and the opportunities and challenges of investing in interventions that address patients’ non-medical, health-related social needs and health care spending. The presentations illustrate a range of innovation and experimentation and underscore the need to advance evaluation methods, including those to assess ROI for different types of investors to further build the evidence base and the business case for investing in non-medical, health-related social needs.
ORGANIZATION OF THE PROCEEDINGS
An independent planning committee organized this workshop in accordance with the procedures of the National Academies. The planning committee’s members were John Auerbach, Seth A. Berkowitz, Dave Chokshi, Deidra Crews, Karen DeSalvo, Arvin Garg, Maurice Jones, and Daniel Polsky. This Proceedings of a Workshop summarizes the presentations and discussions. Chapter 2 recounts the stage-setting keynote address that opened the workshop and the subsequent panel session that provided perspectives on investing in individuals’ unmet social needs and community-level social determinants. Chapters 3, 4, and 5 examine a range of interventions for addressing unmet social needs. Chapter 6 discusses issues involving the ROI for various interventions, and Chapter 7 identifies research gaps that need to be filled. Chapter 8 concludes the
proceedings with reflections on the day. Appendix A contains the workshop Statement of Task. Appendix B contains the workshop agenda and Appendix C provides biographical sketches of the workshop speakers. The workshop speakers’ presentations have been archived online as PDF and video files.3
In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. This Proceedings of a Workshop was prepared by workshop rapporteurs as a factual summary of what occurred at the workshop.
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3 For additional information see http://www.nationalacademies.org/hmd/Activities/PublicHealth/ReducingHealthCareSpendingThroughInterventionsAddressNonMedicalHealthSocialNeeds/2019-APR-26.aspx (accessed May 31, 2019).
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